Therapy Plus Medication No Better Than Medication Alone?

I have
always heard, and always believed, that medication plus therapy was better than
either treatment alone in the treatment of major disorders like major
depression and bipolar disorder. This was the information given to me by my
first doctor and the information I have relayed to countless others.

Moreover,
it’s the information that guides current treatment recommendations. In minor
depression, therapy should be the first course of treatment whereas with major
depression medication and therapy should be frontline treatments.

But an
analysis came out that reviewed the data on the effectiveness of medication
with therapy and the results really surprised me—no significant benefit was noted when participants with chronic
depression were given therapy plus medication when compared to medication
alone.

What the Analysis Revealed

The
analysis was of a small number of studies—only nine —as only nine met their
inclusion criteria of being scientific, randomly controlled and other criteria.
Of these nine, it was noted that the results varied greatly between studies and
the analysis sought to understand why.

It was
found that people the therapy plus medication treatment was more effective when
the therapy was cognitive
behavioral than when it was interpersonal. It was also found that people
with chronic depression benefited more than those who were dysthymic (a more
minor chronic depression). These effects partially explained the differences in
study outcomes but were, in and of themselves, insignificant.

It was
found that non-selective-serotonin reuptake inhibitor (SSRI) medication plus
therapy showed a statistically significant greater effect than non-SSRI
medication alone whereas this effect was neutralized with SSRI medication. It
is not known why this is the case.

Problems with the Analysis

The
authors of the analysis freely admit that due to data variance (and they looked
at the data from all angles) and limited number of studies included that these
results are not conclusive.

Certainly
more work would have to be done to show whether these results are truly
meaningful.
Also the statistically insignificant variance among some variables may turn out
to be significant with more research and other variables may turn out to be
important.

The main
problem I have with any study that uses “therapy” is that therapy varies widely
even within type so that comparing therapy to therapy is rarely like comparing
apples to apples. I suspect the data variance has more to do with this than
anything else; however, this is simply an intrinsic barrier to studying the
effectiveness of therapy.

After
all, there is no such thing as ten milligrams of therapy.

The Good News

The good
news is that while the depression scores were not significantly better for
those that received medication plus therapy when compared to medication alone;
their quality of life scores were statistically significantly better (although
the effect was small).

What Did We Learn?

As I
said, I would be hesitant to draw any sweeping conclusions due to the analysis
limitations, but the important thing, to me, is that therapy does appear to help
people in one important way—in quality of life. And I would call that
significant.

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